Lecture 18: Cancer Metabolism and Treatment

Question 1

comparison (%) of the standard diet and the ketogenic diet

Answer 1

components - standard diet - ketogenic diet:
* carbohydrate - 62 - 3
* fat - 6 - 72
* energy (kcal.gr) - 4.4 - 7.2
f/ (p + c) = 0.07 - 4

Question 2

can ketogenic metabolic therapy (KMT) help manage cancer?

Answer 2

a 1995 study found that the ketogenic diet, which reduced blood glucose and elevated blood ketones (“acids produced by the liver when the body breaks down fat for energy”), could provide long-term management in 2 children with recurrent inoperable brain tumors

Question 3

press-pulse

Answer 3

• a novel therapeutic strategy for the metabolic management of cancer
• by creating both chronic (“press”) and acute (“pulse”) metabolic stress on tumor cells, essentially starving them of energy while protecting healthy cells
• often achieved through a combination of dietary interventions like a ketogenic diet and targeted drugs that disrupt cancer cell metabolism

Question 4

glioblastoma (GBM)

Answer 4

• the most common primary brain tumor in adults
• GBM patient survival under current “standard of care” from five surgical institutions has had no improvement in 100 years

Question 5

how the standard of care can provoke GBM growth and recurrence

Answer 5

• steroids increase glucose
• surgery and radiation increase glutamine in tumor micro-environment

Question 6

Brittany Maynard

Answer 6

• GBM diagnosis Jan 14, 2014
• chose to die

Question 7

Pablo Kelly

Answer 7

• GBM diagnosis Aug 2014
• survived almost 10 years after his approximate death window of 1 year on keto
• died from cerebal hemorrhage following the routine debulking of his glioblastoma

Question 8

Danny Sheehan

Answer 8

• diagnosed Jan 2017, died Aug 2021
• died from pineoblastoma with tumor cell spread through spinal column

Question 9

examples of keto working

Answer 9

• in mice: SD control mice were fat, diet/drug treatment targeting glucose & glutamine simultaneously were normal sized
• in end-stage breast cancer: metabolically supported chemotherapy helped greatly reduce the tumor cells spread across the body
• in a dog: a raw KD-R on mast cell tumor in a 9-yr old dog helped it die at 15 yrs old from heart failure rather than cancer—no surgery, no radiation, no chemotherapy, “autolytic cannibalism”

Question 10

Opdivo

Answer 10

a prescription drug that treats many types of cancer by helping the body’s immune system fight cancer cells
* financial toxicity: initial 12-week phase is $141,000 + $12,500/mo. for Opdivo alone after that = $256,000/1st yr, $150,000/yr. after that
* physical side effects: fatigue, rash, itching, cough, upper respiratory tract infection, swelling of the extremities, shortness of breath, muscle pain, decreased appetite, nausea, vomiting, constipation, diarrhea, weakness, swelling, fever, abdominal pain, chest pain, joint pain, weight loss

Question 11

hyperprogressive disease in patients with advanced non-small cell lung cancer treated with PD-1/PD-L1 inhibitors or with single-agent chemotherapy

Answer 11

• PD-1/PD-L1 inhibitors: a type of immune checkpoint inhibitor (ICI) that can help treat cancer
• single-agent chemotherapy: chemo drugs can be given alone (single agent) or two or more drugs can be given together (combination chemotherapy)

Question 12

desperation oncology

Answer 12

“Immunotherapy drugs can have severe side effects that can even lead to death. Once the immune system is activated, it may attack normal tissues as well as tumors. The result can be holes in the intestines, liver failure, nerve damage that can cause paralysis, serious rashes and eye problems, and problems with the pituitary, adrenal or thyroid glands. Side effects can arise during treatment or after the treatment is finished.”